Is homebirth legal?

I didn't know midwives were still around; isn't that practice for the poor and uneducated?

Is homebirth safe?

What happens if something "goes wrong"?

Won't I also need to go to see a doctor, during my pregnancy?

Doesn't the area where I give birth need to be sterile, as in the hospital?

Does my baby or I need to go to the hospital or a doctor immediately after birth?

Does insurance cover homebirth?

What conditions will "risk out" a mother from midwifery care?

Can I have a homebirth (HBAC/VBAC) after a previous cesarean section (c-section)?

Can I have a homebirth even if I am pregnant with twins or a breech baby?

What about pain relief? I have a low tolerance for pain!

I really would love to have a homebirth, but I should have my first baby in the hospital, "just in case".

What equipment do you carry for births?

I've heard birth is messy, I would hate to have a huge mess to clean up!

 

Is homebirth legal?

Yes! Homebirth is legal everywhere! Some states (NOT Texas) prohibit midwives from practicing midwifery (click here to view the legal status of midwives in your state). Homebirth and midwifery are VERY legal in Texas! It is your right as a woman and as a family to choose where you would like to give birth. Whether in a hospital or at home. Some families choose to have unassisted births, while others choose to have a midwife or two in attendance. After researching all of the options that are available, and there are so many, I encourage all pregnant women to make the decision based on what feels right for them.

 

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I didn't know midwives were still around; isn't that practice just for the poor and uneducated?

Yes, we are still around, and NO midwifery is absolutely NOT just for the poor and uneducated. In the past, the more wealthy women in the US decided that they wanted more "exclusive" care mainly because they could afford it and wanted to be able to throw money at the "problem" of pain in childbirth. Therefore, they could be knocked out with general anesthesia and wake up with a baby in the nursery. At the same time, midwives were women of the community, with knowledge of birth that was either handed down through the generations or through some training. They did serve the lower class of women. There was a time, before all of this occurred, when midwives served ALL women, wealthy or not. This is currently the state of midwifery! We serve ALL women, and our care is exactly the same for ALL women!

 

Midwives are now regulated at a state and national level. First, we are certified by the North American Registry of Midwives (NARM), then we are licensed by the Texas Department of State Health Services (DSHS) Midwifery Board. Gone are the days of "just being the neighborhood midwife". Our training is extensive and intensive! And MANY requirements must be met prior to even being considered for the National Midwifery Exam. Following the completion of the exam, additional requirements must be met and we must fulfill yearly continuing education requirements, just as Texas state licensed physicians and nurses. Midwives of Texas are constantly studying to continue gaining knowledge to make birth even better and safer for their clients!

 

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Is homebirth safe?

ABSOLUTELY! Homebirth is safe, if not SAFER than labor and birth in the hospital setting. This is a surprising thing for some people to hear. It must be said that the misconception that labor and birth are "emergencies" that must be "managed", is very wrong! For a low risk, complication-free pregnancy, labor and birth are simply the end of pregnancy. The body will go into labor on it's own and the baby will be born safely with little or NO /assistance/intervention. It is as simple as that. At the beginning of your care with a midwife at Alamo Area Midwifery, you will go through a screening process and all homebirth "risks" will be identified. It has been found in several large studies, when a planned homebirth, (following a complication/risk-free pregnancy, with prenatal care) is conducted under the watchful eye of a Certified Professional Midwife, it has been found to be a statistically safer environment and event than birth in the hospital. Click to read the latest study conducted regarding CPMs and Homebirth. Homebirth has been found to have far lower rates of medical intervention and the same or lower rates of intrapartum (labor and birth), complications and infant mortality.

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What happens if something "goes wrong"?

This is the first question asked by most parents interested in homebirth. When asked to address specific "wrongs", most parents cannot note very many. My answer is this: there are VERY FEW complications that will arise in labor, birth and postpartum/newborn times, with the very limited number of interventions that are implemented in midwifery. And there are very few issues that cannot be predicted with the high level of prenatal and intrapartum care provided within midwifery care. Labor and birth are not filled with the drama that is seen on TV with a laboring woman screaming and the doctor rushing in to save the lives of everyone involved. It really is a natural process that can take place with little to no problems. However, there are complications that can happen, BUT all are easily seen and very much watched for during the course of labor and birth. There are very few emergencies within labor and birth that cannot be solved by a competent and highly trained midwife, in the home.

 

The following is a short list of the (very rare) "wrongs" that could happen and how they are usually resolved:

Failure to progress - meaning labor is not strong enough to deliver a baby or there is some sort of umbilical cord entanglement that is preventing the baby from moving into the birth canal. A weak labor can be a result of an emotional issue with the mother and us usually easily resolved, by identifying the issue and talking through it. Additionally, this can also be a result of the mother not having adequate rest or food and drink, all three of which are encouraged in homebirth. If cord entanglement is the problem, the baby is simply wrapped up in the cord and the midwife can verify this by listening to the different sounds of the umbilical cord and heart tones with the doppler device. This is not an emergency, as long as baby's heart tones are at normal levels. At times a visit to the hospital may be necessary for delivery, as the hospital has additional augmentation drugs to make labor stronger and the ability to perform a c-section, if necessary.

 

Non reassuring Heart Tones - The normal range of fetal heart tones is between 120 and 160 beats per minute. There is a slight allowance for variation from these numbers, if the baby's baseline in pregnancy is at the low or high end of this range. In labor, there are different stages at which the baby's reaction to the contractions will change, and this is heard through observing the patterns of heart tones. Midwives are highly trained in listening. We listen to everything and our trained ears can hear changes that are considered normal and changes that deviate from normal. Again, we have very specific protocol for "what to do" when we come across deviations from normal. And there are very specific variations that match up with very specific issues and complications with the baby. Most of which are easily resolved and do give plenty of time to make a transfer of care to the nearest hospital.

 

Postpartum Hemorrhage - at times, the uterus becomes "tired" after a long or very strong, fast labor. After delivery of a baby and the placenta, the uterus must "clamp down" or contract to stop bleeding from where the placenta was attached inside of the uterus. If the uterus does become tired, it will simply stop all work to rest. This will result in a postpartum hemorrhage. First of all, this is rare in homebirth, since labors are not induced or augmented with powerful, synthetic hormones (Pitocin) as is commonly done in the hospital. Therefore the uterus usually doesn't become overworked and will do it's job after the birth. If, in a rare circumstance, a mother does have a postpartum hemorrhage, we are trained and have VERY specific protocol for stopping the bleeding. First, massage is used, along with herbal remedies, followed by pharmaceutical elements, if bleeding surpasses amounts in our guidelines. We are also trained in IV fluid replacement for emergency situations. And at any time we feel that this emergency exceeds our "scope of practice" we will alert emergency response services and the mother will be taken to the nearest hospital. Again, we are trained to monitor the amount of bleeding taking place following a birth and we act very quickly if bleeding approaches "abnormal".

 

Baby Not Breathing - following the delivery of the baby, we allow the baby to "blossom". Most babies will come out into the mother's own hands and she will pull him or her up to her own chest. That baby will then be covered in a warmed towel and be given the chance to take in this new and bright sensory environment! We do not "rub-up" the new baby to get him or her to cry. This practice is unnecessary and is even being "denounced" by neonatal resuscitation instructors. It is too much sensory stimulation, shocking and painful to the new baby! In homebirth, the standard of practice is to leave the umbilical cord attached to the placenta until the cord stops pulsing or the placenta is delivered. So, the baby is still receiving oxygen to his or her brain from the placenta. Most babies will peek up at their parents and breathe quietly while taking in all of the new sights! We immediately look at the baby's coloring and listen to their heart and breathing rates, with the minimal amount of invasion on these magical first few moments of the baby being out in the world! There are the rare few who need a little help to take their first breath. It is for this very reason, all midwives are trained and certified in Neonatal Resuscitation. The midwives of Alamo Area Midwifery carry oxygen and a neonatal resuscitation setup, complete with bag-valve-mask resuscitator to every delivery. If resuscitation is begun, emergency medical services are activated at the same time.

It is when interventions are applied that the complications will invariably arise. We are trained and mandated to identify any and all complications as they arise in pregnancy, labor, birth and the postpartum times. If at any time a complication come up we follow certain protocols and guidelines which lead us to solve the issues or to refer or transfer care.

 

Many second or third time mothers and experienced-mother-friends of women considering a birth at home will present certain scenarios to the mother or to me, usually saying "well, if I hadn't been in the hospital, my baby would have died". This is difficult to respond to, without offending (or pouring salt on the wound). This may have been true, but it really is rare that it IS actually true. In the hospital, one intervention begets the next. And by the end of all of these interventions, you end up with a very dramatic birth and a baby that needed to be rescued.

 

If the mother could have avoided going to the hospital in early labor or her water would not have broken before labor began (as a result of her cervical dilation being checked "very roughly" in the office earlier that day), she would not have needed to have a pitocin induction or augmentation in order to stay on the physician's 12 hour-time frame for labor and birth. In having pitocin, the mother, who planned on having a natural, drug-free delivery, now wants an epidural to have some pain relief from the VERY INTENSE Pitocin contractions. Immediately following the epidural placement, the baby's heart tones crashed (which is very common), along with the mother's blood pressure. The nurse and anesthesiologist are then unable to shift the mother's position enough to help the baby to recover and the mother is rushed to the obstetrical operating room, where she undergoes the very commonly heard of "emergency c-section", 30 minutes later. After the baby is taken from the womb, he is floppy and gray from lack of oxygen. The neonatal technicians and nurses work hard to resuscitate him and he is revived quickly.

 

Yes, this is a very dramatic scenario. And yes, it absolutely would make the parents think that since their baby was on the brink of death, they were better off delivering in the hospital. However, it simply isn't so. It was absolutely a result of the hospital and the staff within the hospital. If she WASN'T in the hospital, none of the issues would have been introduced in the first place and she could have possibly had a much gentler labor and delivery.

 

There are alternatives to everything and everything must be questioned when it comes to the health and safety of you and your baby. In midwifery care, we pay special attention to making sure everyone is safe AND has a very positive birthing experience. Reexamine this scenario and find what went wrong and why.

 

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Won't I also need to go to see a doctor, during my pregnancy?

No. As defined by the DSHS Midwifery Licensing Board: Midwives in the State of Texas are licensed to provide the necessary supervision, care, and advice to a woman during normal pregnancy, labor, and the postpartum period; conducting a normal delivery of a child; and providing normal newborn care. ("Newborn" means an infant from birth through the first six weeks of life.) During pregnancy, birth and postpartum times, there are rare complications that can arise; there are also other issues that are out of the scope of midwifery practice. In these rare cases, you may receive a referral or transfer of care from the midwife, depending on the severity of the issue. In which case, it would be recommended that you visit a physician. And many times, you may still continue care with the midwife, if all problems are addressed and/or solved.

 

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Doesn't the area where I give birth need to be sterile, as in the hospital?

First of all, hospitals are one of the dirtiest, most germ ridden places in existence. Think of all of the truly sick people in the hospital. The existence of MRSA infections that are rampant in most hospitals should be enough to deter any parents from wanting to deliver their new baby in the hospital. Birth is not a sterile event either, simply think of the area in which it is occurring. Now, consider this: you live in your home, you have all of the germs that you would get from your home and your home has all of the germs it will get from you. Unless you plan on delivering on a very dirty floor or pest infested area in your home, cleanliness is not an issue. That said, as midwives, we make every effort to use the practice of Universal Precautions, just as any doctor or nurse would use in the hospital when doing an exam, during the delivery, during the newborn exam and the Sterile Technique is practiced if any repair is necessary following birth. We exercise great caution to prevent any infection during and after birth and we take pride in our 100% success rate/0% infection rate.

 

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Does my baby or I need to go to the hospital or a doctor immediately after birth?

No. As stated before, midwives in Texas are licensed to provide care to the normal, healthy mother and baby from the prenatal time until 6 weeks after birth. As long as no complications are found by the midwife, there is no reason to seek the care of a physician. Going to the hospital or physician immediately following the delivery, may actually cause more harm than good. As a childbirth at home strikes fear and concern into the hearts of most medical personnel and you will be considered an "emergency case" even if all is well with both you and the baby.

 

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Does insurance cover homebirth?

Yes. In Texas, if you have a preferred provider insurance plan, midwives will be covered. Since there are no homebirth midwives contracted with any insurance company (and according to Texas Insurance Board law, midwives meet the definition of Health Care Provider) the plan must pay for midwifery services (prenatal care, labor, birth, labs, postpartum care and newborn care) at in-network rates. There are some plans that prefer to be contacted by the patient rather than the midwife. In these cases, a payment plan is determined between the midwife and the client and the client will file claims to the insurance company. Many times all is necessary is a request for an "In-Network Exception". Since not all health insurance companies will allow Licensed Midwives to obtain provider numbers and will not allow Licensed Midwives to be contracted with the plans, the process is slightly more involved for the client. However, this involvement is a great show of the reality of the partnership that is formed between midwife and client. In working together, you can have an amazing birth and save a great deal of money with midwifery care! Read more about the Texas Insurance Code statutes here.

 

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What conditions will prevent a mother from having midwifery care and a homebirth?

There are certain situations and conditions where homebirth is not recommended. Some conditions are even dangerous and must be attended to by a licensed physician in the hospital. We are trained to screen for these preexisting conditions. At the first visit, prior to signing the Homebirth Contract, we will make appropriate referrals and recommendations for any potential client, presenting with any one of the following conditions:

 

Preexisting Diabetes

Thyroid Disease

Tuberculosis

Chronic Lung Disease

Severe Asthma

Epilepsy

Clotting Abnormalities

Rh Negative WITH antibodies (as determined with the initial OB Panel blood test)

Severe Anemia (also determined with the OB Panel)

Acute Viral Infection (most determined with initial blood testing)

Congenital Heart Disease

Renal Disease

Extreme Obesity (with history of medical problems)

Tobacco Use (with no plans of cessation)

Malnutrition (including poor eating habits; a nutrition evaluation will be part of the initial prenatal care)

Drug Addiction

Moderate to Heavy Alcohol Use

Heavy Caffeine Use (more than 10 cups of coffee, cola, tea, energy drinks daily)

Preterm Labor & Delivery (before 36 weeks)

Psychological problems
Polyhydramnios

Sexually-transmitted diseases
Abnormal fetal growth
Postmaturity

Placenta Previa & Acreta
Active herpes eruptions at time of labor

Two or more cesarean sections or a cesarean section with a vertical incision.

 

The above conditions and lifestyle factors can present very serious problems in pregnancy, fetal growth, labor and delivery, the newborn and in the postpartum times. Midwives are trained and licensed to care for women with uncomplicated and risk-free pregnancies. Contact us if you have any questions regarding any possible complications you think you may have that could preclude you from midwifery care and we can make further determinations.

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Can I have a homebirth (HBAC/VBAC) after a previous cesarean section (c-section)?

Absolutely! VBAC has not quite made the comeback that we hope for in the hospital setting. In San Antonio, the old adage is still typically "once a c-section, always a c-section". Except at home! Most midwives have been pleased to adhere to the newly published data, stating that VBACs are safe when protocols and guidelines are followed. The VBAC mother, in a subsequent pregnancy, must have had previous cesarean with a very low, transverse-horizontal incision, performed at least at 28 weeks or later, having had no more than 2 c-section, at least 18 months between c-section and beginning of the following pregnancy, has great nutrition and health and is willing to have two ultrasounds to verify the location of the placenta.

 

Again, when uninterrupted and intervention-free (no augmentation with Pitocin or Cytotec) VBAC is far safer than a repeat cesarean. The risk of uterine rupture (which is the main point for most hospital bans on VBACs) is 0.2% when no augmentation is used. With a skilled provider, trained in screening out and monitoring for signs and symptoms of the rare uterine rupture a mother can easily, GENTLY and successfully have a vaginal delivery. It has been found that these safe VBAC mothers should be cared for no differently than the repeat vaginal birth mothers. We GLADLY welcome VBAC mothers, we can assist in healing all wounds (emotional and physical) from unnecessary cesareans.

Click here to read more information about VBAC.

 

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Can I have a homebirth even if I am pregnant with twins or a breech baby?

Yes! In fact, home is usually the safest place for these sweet little ones to arrive at, when assisted by a verifiable skilled and preferably licensed birth professional. In this area (San Antonio), women who plan to deliver in the hospital and who are pregnant with twins or a breech baby, will usually have an automatic c-section delivery. The doctors like to state that it is simply because they want to do what is best for the baby. A c-section isn't always what is best for the baby. Having attended several breech deliveries and even assisted at the home delivery of triplets, early in my training, I can say that these "variations" from normal have been amazing and still very gentle experiences for both mom and baby. It is very important to find a midwife who is skilled in these types of deliveries, as they require a slightly different technique. This midwife should also have a great support system and have several licensed and experienced, assistant midwives attending the delivery along with her. The mother should also be encouraged to maintain a strict, very healthy, nutrient rich diet and maintain a very healthy lifestyle throughout her pregnancy and postpartum.

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What about pain relief? I have a low tolerance for pain!

Surprisingly, childbirth is very gentle and tolerable when it is uninterrupted and intervention free. What you see on TV and movies is nothing like the real thing. I won't lie and say that birth is painless; labor and birth can be very intense at times, but when the intensity rises, it usually means that you will have a baby in your arms in just a short amount of time. At home, since the epidural and other drugs commonly used in today's hospital births are unavailable, we make use of far more natural methods of pain relief. The first being one of the most amazing tools available...WATER! The blissful look on the face of every woman who slips into a very warm tub of water for the first time in labor is priceless! It truly is surprising how the warm water instantly relieves the achy, waves of contractions. Aside from the water, we are also trained in administering several different, very effective, types of herbs and homeopathic remedies, massage points, use of position changes, ice, hot packs, warm oil and many other techniques for relieving that pain of labor. I have told almost every laboring mother one of the lines from the BIRTH! performance: 'It's only ONE day'. And in that performance, it was meant in a more dismissive way. In the way that I put it out there, I am saying that 'It's only ONE day, (or less), of annoying, achy, possibly blissful, contractions'...and once the baby is out, all of the pain of labor instantly stops!. It really is a very small price to pay to ensure a healthy, natural, intervention-free, gentle home delivery of your baby. You can do it for just ONE day!

 

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I really would love to have a homebirth, but I should have my first in the hospital, "just in case".

This is a dangerous statement to allow out of your mouth. I really encourage parents, namely mothers, to listen to that inner voice. What does it tell you? What feels right to you? If you feel that birthing in a hospital is the only way you will feel safe, then that is where you should be, because fear and anxiety can cause labor to stop completely. But, if you feel strongly that homebirth would be an amazing way to go, really consider that feeling. Too many mothers have huge regrets and gaping emotional wounds to heal from previous hospital birthing experiences (unfortunately it is built into our job description to provide emotional healing from previous hospital birth trauma), when they had this exact statement "I would love to have a homebirth, but I don't know what to expect and I would like to be in the hospital "just in case". Either way, you will not know what to expect. All births are very different, even with the same woman. And think about this: you can always choose to go to the hospital during a homebirth. Just because you choose to labor and birth at home, you are not bound to the home if you become too uncomfortable with the pain or with the anxiety of the unexpected. I have never met a set of parents who had regrets about their homebirth; I have, however, met plenty who have terrible regrets about birthing in the hospital. It is too huge of a live event to play around with, do it the way you feel is the right way and don't second guess yourself!

 

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What equipment do you carry for births?

When we arrive for your birth, it will look as if we are moving in for a month! We carry supplies for each stage of labor, birth, postpartum and newborn times. We have the doppler, blood pressure monitor, thermometer, herbal tinctures and homeopathic remedies, gauze, underpads, antiseptics, gloves, swabs for identifying ruptured membranes, IV administration setup, sterile clamps and scissors for cutting the umbilical cord, oxygen tank, oxygen mask for mother, resuscitation setup for newborn with bag-valve-mask resuscitator / warming tray / stethoscopes / delee suction / nasal aspirator, sterile surgical instruments, numbing medication and sterile sutures for laceration repair, postpartum herbal tinctures and pharmaceutical elements for postpartum hemorrhage, baby scale, tape measure, umbilical cord clamps or cord ring, erythromycin eye ointment, newborn screening equipment, appropriate hazardous waste disposal containers. Basically we turn your bedroom, bathroom, dining room or kitchen into a birthing suite with all of the necessary amenities for a safe and healthy labor and birth.

 

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I've heard birth is messy, I would hate to have a huge mess to clean up!

My motto and the motto of many of the area midwives is that we leave your home cleaner than it was before we arrived. As you labor in private with your partner or as you rest, we will usually occupy ourselves (when we are not charting your activity) by washing your dishes or picking up toys. We also take great precautions to ensure that all surfaces are protected during any exam or during delivery, so there is no issue with messiness. Underpads are used and switched out frequently. We "clean as we work" during the birth, and after the birth, while you are visiting with your new little person, we work hard to clean up all birth areas and we will throw all birth laundry into the washing machine. I once saw this concern addressed in a pregnancy and childbirth book as being the largest deterrent to homebirth. I was appalled! This is totally a non-issue and should be the least of a pregnant, homebirthing couple's worries. Let your friends and family know, the house will not look like a massacre occurred, it will be sparkling clean and they are welcome to come visit the newly completed family!

 

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